Women's Perceptions of Barriers and Facilitators to Vaginal Birth After Cesarean in the United States: An Integrative Review

Abstract

Introduction The purpose of this integrative review was to synthesize the literature on women's perceived barriers and facilitators to achieving a vaginal birth after cesarean. Methods A search of Scopus and PubMed databases and relevant citations from 2000 to 2018 was conducted to identify resources meeting inclusion criteria. Conclusion drawing and verification were completed using data displays, data analysis, and comparison. Results Sixteen resources met inclusion criteria. Factors identified by women with a history of cesarean that act as facilitators or barriers to achieving a vaginal birth after cesarean included (1) individual factors (knowledge, body, and psychological), (2) social factors (culture and social support), and (3) systemic factors (perinatal care provider, health system, and financial). Some factors related to barriers and facilitators reflected opposing aspects of the same phenomenon on a continuum. Discussion Enhancing facilitators identified by women, while addressing perceived barriers, may increase access to labor after cesarean for women in the United States. Increasing access to labor after cesarean may subsequently improve women's experiences of care and decrease the US cesarean rate, positively affecting individual health outcomes and overall health of childbearing women in the United States.

“I had to fight for my VBAC”: A mixed methods exploration of women’s experiences of pregnancy and vaginal birth after cesarean in the United States

“…Similar to the findings of our integrative review, 31 researchers in high resource countries have noted that VBAC rates correlate with levels of maternal knowledge about options for birth after cesarean, and access to VBAC supportive providers and birth settings 45‐48 . In this study, as in others, participants viewed their provider as a valuable source of information about pregnancy and birth, 49 and perceived a supportive clinician as a key facilitator for a successful VBAC 31,45,47 . A positive relationship with a provider is of critical importance 50 and provider preference for mode of birth significantly affects a person's choice 51,52 …”

“…Their search was complicated by VBAC bans in hospitals, sometimes requiring them to travel more than an hour to obtain a VBAC. Similar to the findings of our integrative review, 31 researchers in high resource countries have noted that VBAC rates correlate with levels of maternal knowledge about options for birth after cesarean, and access to VBAC supportive providers and birth settings 45‐48 . In this study, as in others, participants viewed their provider as a valuable source of information about pregnancy and birth, 49 and perceived a supportive clinician as a key facilitator for a successful VBAC 31,45,47 .…”

“…Our sample trended in this direction; nearly 40% of participants who planned a VBAC had a midwife provider for their second birth, a rate that is significantly higher than the United States as a whole where only about 10% of people give birth with a midwife 57 . Those who planned a VBAC were more likely to travel more than an hour for their second birth, indicating that access to hospitals or providers offering VBAC is a significant obstacle, echoing findings of other studies 31,58 …”

“…Very few studies describe the experiences of people who desire a VBAC, despite a decade of nationally‐representative surveys reporting that nearly half of US women interested in planning a VBAC were denied the opportunity 28‐30 . One recent review of literature indicated that people often have to go to extraordinary lengths in order to attempt a VBAC 31 . The purpose of this study was to investigate how US women who desired a VBAC navigated a subsequent pregnancy and childbirth.…”

Barriers to labor after cesarean: A survey of United States midwives

“…In a review of women's perceptions of barriers and facilitators to LAC in the United States, Ibrahim et al 16 found lack of practitioner support a significant barrier to women desiring LAC. Bernstein et al 17 prospectively followed LAC candidates through pregnancy and found they were poorly informed about their options and heavily influenced by perceived practitioner preference for mode of birth.…”